Basic Information Your name Your email Preferred Phone: Phone Type: CellHome Texting Preference: Texting OKNo Texting Street Address City State Zip How did you hear about us? Do you have skills and interests that you would like to share with our residents? Emergency Contact Name Relationship Phone: References Reference one Name Name of Organization Phone: Reference two Name Name of Organization Phone: Location EHM Senior Solutions has two campus locations in Saline and a variety of volunteer opportunities. The Evangelical Home – Saline is a skilled nursing facility for long-term care located at 440 West Russell Street near Mill Pond Park. Brecon Village, an independent and assisted living residence with a Memory Support Center, is located off N. Ann Arbor-Saline Road at 200 Brecon Drive. At what location would you like to volunteer? The Evangelical Home – SalineBrecon Village Availability Please indicate when you are available: Monday MorningAfternoonEvening Tuesday MorningAfternoonEvening Wednesday MorningAfternoonEvening Thursday MorningAfternoonEvening Friday MorningAfternoonEvening Saturday MorningAfternoonEvening Sunday MorningAfternoonEvening Please indicate if you can volunteer WeeklyMonthly Interests Please indicate how you are interested in volunteering: One on One Visits- Visiting with ResidentsBest Friends- Building a special relationship with one residentGroup Activities- Helping with residents during scheduled activitiesVolunteering as a GroupOutdoor Activities-walking with residents, gardening, craftsOutdoor Facility Care- Decorate windows, fill birdfeeders, work projectsTrips/Outings- Accompanying residents and staff on tripsPrep Work- Prepping for projects in facility or at homePrograming- Creating activities for residentsEvents or HolidaysOther (indicate below) Covid-19 Vaccination Status Volunteers are not required to be vaccinated. For the safety of our residents, staff, and volunteers, we require volunteers working directly with residents to be tested for Covid-19 at the facility prior to shift. I have had the vaccination for Covid-19 (enter date if yes) I have had the vaccination booster (enter date if yes) Parental Consent (Required If Under Age 18) I authorize my child to participate in the EHM Senior Solutions Volunteer Program. Parent name Submit Checking this box serves as your digital signature. Thank you so much for applying to volunteer with our residents. The offering of your time, presence, compassion, and love is appreciated. Please know that you will make a difference. EHM Senior Solutions is proud to walk with you on your journey of service.
